-
Journal of Vascular Surgery Mar 2021Wound complications after major lower extremity amputations (LEAs) are a cause of significant morbidity in vascular surgery patients. Recent publications have...
OBJECTIVE
Wound complications after major lower extremity amputations (LEAs) are a cause of significant morbidity in vascular surgery patients. Recent publications have demonstrated the efficacy of the closed incision negative pressure dressing at preventing surgical site infections (SSIs); however, there are few data on its use in major LEAs. This study sought to assess if closed incision negative pressure wound therapy (NPWT) would decrease the risk of complications as compared with a standard dressing in patients with peripheral vascular disease undergoing major LEA.
METHODS
Fifty-four consecutive patient limbs with a history of peripheral arterial disease underwent below-knee or above-knee amputations. This was a retrospective review of a prospectively maintained database from January 2018 to December 2019, and it included 23 amputations in the NPWT group and 31 amputations in the standard dressing group. NPWT using the PREVENA system was applied intraoperatively at the discretion of the operating surgeon and removed 5 to 7 days postoperatively. The standard group received a nonadherent dressing with an overlying compression dressing. Amputation incisions were assessed and wound complications were recorded. Student's t-test and two-sample proportion z-test were used for statistical analysis. A P value of less than .05 was considered statistically significant.
RESULTS
For comorbidities, there was a higher incidence of tobacco use in the NPWT as compared with the standard group (44% vs 13%; P = .011), as well as trends toward increased prior amputations, anemia, hyperlipidemia, and chronic obstructive pulmonary disorder in the NPWT group. For risk factors, there were more dirty wounds in the NPWT as compared with the standard group (52% vs 26%; P = .046). For outcomes, there were fewer wound complications in the NPWT as compared with the standard group (13% vs 39%; P = .037). The types of wound-related complications in the NPWT group included one wound dehiscence with a deep SSI, one superficial SSI, and one incision line necrosis. In the standard group, there were four wound dehiscences with deep SSI, three superficial SSIs, four incision line necroses, and one stump hematoma. The rates of perioperative mortality and amputation revision did not differ significantly between the NPWT and the standard groups (3% vs 4% and 4.3% vs 10%, respectively).
CONCLUSIONS
Closed incision NPWT may decrease the incidence of wound complications in vascular patients undergoing major LEA. This held true even among a population that was potentially at higher risk. This therapy may be considered for use in lower extremity major amputations.
Topics: Adult; Aged; Aged, 80 and over; Amputation, Surgical; Comorbidity; Databases, Factual; Female; Humans; Lower Extremity; Male; Middle Aged; Negative-Pressure Wound Therapy; Peripheral Arterial Disease; Retrospective Studies; Risk Assessment; Risk Factors; Surgical Wound Dehiscence; Surgical Wound Infection; Time Factors; Treatment Outcome; Wound Healing
PubMed: 32707380
DOI: 10.1016/j.jvs.2020.07.061 -
PloS One 2019The disease of freshwater sponges was first discovered in 2011, when pink samples were found in the Central Basin of Lake Baikal. Subsequently, the visible signs of the...
The disease of freshwater sponges was first discovered in 2011, when pink samples were found in the Central Basin of Lake Baikal. Subsequently, the visible signs of the disease have changed, and now sponges appear with various symptoms of damage to the body, such as discoloration, tissue necrosis, the formation of brown patches and dirty-purple biofilms on some branches. These signs of the disease are accompanied by the mass death of sponges. We identified differences in microbiomes by sequencing 16S rRNA genes and found changes in the consortium of microorganisms of freshwater Baikal sponges. We found that the observed imbalance in the studied microbial communities of diseased sponges is caused by several different conditionally pathogenic microorganisms that increase their negative effect by acting together and in concert, which leads to the death of photosynthetic microalgae and sponges. Sponges are an important component of coastal communities, and the massive loss of sponges can obviously affect the structure of benthic communities and the purity of water.
Topics: Animals; Biodiversity; Genes, Bacterial; Host Microbial Interactions; Lakes; Microbiota; Porifera; RNA, Ribosomal, 16S; Russia
PubMed: 30921366
DOI: 10.1371/journal.pone.0213926 -
Operative Orthopadie Und Traumatologie Oct 2018Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft... (Review)
Review
OBJECTIVE
Debridement of soft tissue and bone in an open fracture situation to minimize infection risk and achieve primary skin closure, or to provide conditions for early soft tissue coverage.
INDICATIONS
Indications are Gustilo-Anderson grade I-III A-C open fractures.
CONTRAINDICATIONS
Contraindications are injuries requiring amputation, burns, and life-threatening injuries which make appropriate treatment temporarily impossible.
SURGICAL TECHNIQUE
Removal of gross contamination and macroscopic contaminants; debridement of the wound; complete resection of contaminated and dirty tissue; sparse step-by-step resection of contaminated or non-vital wound and bone margins until vital, bleeding tissue begins; low-pressure irrigation with isotonic irrigation fluid; diagnostic biopsies for microbiological testing; reduction of dead space by interpositioning of muscle or cement spacers loaded with local antibiotics; primary wound closure if tension-free closure possible; otherwise, if resources and knowhow permit and satisfactory clean debridement was achieved, local flap; if flap impossible, debridement not satisfactory, secondary tissue necrosis likely, potential remaining contamination or contamination with fecal matter, then vacuum-assisted closure therapy.
POSTOPERATIVE MANAGEMENT
Wound inspection on the second postoperative day, generous indication for second-look surgery after 36-48 h, wound inspection on the second postoperative day, wound inspection every other day, primary antibiotic prophylaxis with a first- or second-generation cephalosporin (e. g., cefuroxime), and adaptation of antibiotic therapy according to susceptibility screening.
RESULTS
Infection rates of 2-4.7% are reported for immediate primary wound closure in Gustilo-Anderson grade I, II, and III A open fractures. For Gustilo-Anderson grade III B, good wound healing, bony consolidation, and no need for secondary surgery was reported in 86.7% when primary wound closure was achieved.
Topics: Anti-Bacterial Agents; Antibiotic Prophylaxis; Debridement; Fractures, Open; Humans; Soft Tissue Injuries; Surgical Flaps; Surgical Wound Infection; Therapeutic Irrigation; Treatment Outcome; Wound Healing
PubMed: 30182178
DOI: 10.1007/s00064-018-0562-8 -
Hernia : the Journal of Hernias and... Dec 2018Synthetic non-absorbable meshes are routinely used in hernia surgery for clean cases but are avoided in the case of clean-contaminated or contaminated hernia or dirty... (Observational Study)
Observational Study
PURPOSE
Synthetic non-absorbable meshes are routinely used in hernia surgery for clean cases but are avoided in the case of clean-contaminated or contaminated hernia or dirty cases to minimize the risk of infection. The present study was conducted to evaluate the outcome of polypropylene mesh in the settings of bowel resection performed for strangulated hernias of the abdominal wall.
METHODS
This prospective observational study was conducted in the Department of Surgery of a teaching hospital in central India between 1st March 2015 and 31st Aug 2017. Adult patients > 18 years age, with abdominal wall hernias, presenting with strangulation, and requiring resection and anastomosis for gangrenous bowel were included in the study. Outcomes noted were wound infection, morbidity and mortality, need for the removal of the mesh, and recurrence of the hernia.
RESULTS
30 (22 men and 8 women) patients with strangulated hernias underwent emergency surgery with resection of gangrenous bowel and anastomosis. The 30 cases included 21 inguinal, seven incisional, one femoral and one umbilical hernia. 12 of the 30 cases having gross contamination of the operative wound due to perforated gangrenous bowel were classified as 'dirty'; while the remaining 18 cases with non-perforated gangrenous herniating bowel were classified as 'contaminated'. Wound infection occurred in 8/30 patients (26.67%); but these healed with antibiotics and dressing. Mesh removal was not required in any patient during entire study period. Two recurrences (6.7%; one inguinal and one incisional hernia) were observed. There was no mortality.
CONCLUSION
The use of polypropylene mesh for contaminated and dirty strangulated hernias is effective and safe, with acceptable morbidity and good short-term results.
Topics: Adult; Aged; Aged, 80 and over; Biocompatible Materials; Female; Gangrene; Hernia, Abdominal; Herniorrhaphy; Humans; Intestine, Small; Male; Middle Aged; Polypropylenes; Prosthesis Implantation; Surgical Mesh; Surgical Wound; Surgical Wound Dehiscence; Surgical Wound Infection
PubMed: 30145621
DOI: 10.1007/s10029-018-1811-3 -
Journal of Fish Diseases Nov 2018Disease poses a major threat to aquaculture and commercial and recreational fisheries globally. Biosecurity measures have been implemented; however, empirical evidence...
Disease poses a major threat to aquaculture and commercial and recreational fisheries globally. Biosecurity measures have been implemented; however, empirical evidence of their efficacy in situ is lacking. Here, we present the results from a study conducted to examine the effectiveness of disinfectant net dips. Samples were collected from disinfectant net dips at 25 recreational fisheries in south-west England and assessed to determine (a) the level of bacterial contamination and (b) the reduction in titre of a target virus (infectious pancreatic necrosis virus, IPNV) following a contact time of 2 and 5 min. In addition, the study examined the reduction in target virus titre following exposure to laboratory prepared Virkon , representing "clean," "dirty" and "diluted and dirty" conditions, for 2 and 5 min. Bacterial contamination was high in 64% of disinfectant samples, and, 76% of disinfectant samples did not effectively reduce the target virus titre in 2 or 5 min. Virus titre was successfully reduced following exposure to laboratory prepared Virkon for 2 or 5 min, although dilution and contamination reduced the effectiveness. These results suggest that disinfectant net dips may not be working effectively on a high proportion of fishery sites. We provide recommendations for improving biosecurity.
Topics: Animals; Bacteria; Bacterial Infections; Birnaviridae Infections; Disinfectants; England; Equipment and Supplies; Fish Diseases; Fisheries; Infectious pancreatic necrosis virus
PubMed: 30091241
DOI: 10.1111/jfd.12868 -
Journal of Clinical Neuroscience :... Sep 2018The prognostic significance of clinical characteristics and neuroimaging features, especially cranial magnetic resonance imaging (MRI)-based neuroimaging features, in...
The prognostic significance of clinical characteristics and neuroimaging features, especially cranial magnetic resonance imaging (MRI)-based neuroimaging features, in patients with human immunodeficiency virus (HIV)-negative cryptococcal meningitis (CM) has rarely been examined in the literature. We analyzed the clinical characteristics and MRI findings of 65 HIV-negative patients (43 men, 22 women, age 19-86 years) collected during a study period of 15 years (January 2001-December 2015). Their underlying conditions included diabetes mellitus, liver cirrhosis, hematologic disorders, autoimmune disorders, malignancy, chronic obstructive pulmonary disease, adrenal insufficiency and organ transplantation, and their clinical presentations included headache, altered consciousness, fever, seizure, visual disturbance and hearing impairment. The main cranial MRI findings were basal meningeal enhancement (44.6%, 29/65), dilated Virchow-Robin space/pseudocyst (43.1%, 28/65), "dirty" cerebrospinal fluid sign (38.5%, 25/65), hydrocephalus (36.9%, 21/65), acute/subacute cerebral infarct (ASCI, 21.5%, 14/65), cryptococcoma (9.2%, 6/65), and hazy brain base (1.5%, 1/65). The therapeutic results of the 65 patients were evaluated using the Glasgow Outcome Scale (GOS). A comparison of the good outcome group (GOS score = 4-5, n = 37) and poor outcome group (GOS score = 1-3, n = 28) revealed that both the presence of seizures and ASCI were significantly associated with the prognosis. A comparison of the groups with ASCI (n = 14) and without ASCI (n = 51) revealed that the presence of basal meningeal enhancement was a significant factor for the development of ASCI, and that this correlation may be associated with intense basal meningeal inflammation in adjacent small vessels.
Topics: Adult; Aged; Aged, 80 and over; Cerebral Infarction; Female; Humans; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Middle Aged; Neuroimaging; Prognosis; Retrospective Studies; Seizures; Young Adult
PubMed: 30042070
DOI: 10.1016/j.jocn.2018.06.044 -
International Journal of Gynecological... Nov 2018Krukenberg tumor, defined as metastatic adenocarcinoma to the ovary containing at least 10% signet ring cells, usually arises from the stomach but can also originate...
Krukenberg tumor, defined as metastatic adenocarcinoma to the ovary containing at least 10% signet ring cells, usually arises from the stomach but can also originate from other sites. We reviewed 17 metastatic breast carcinomas to the ovary with signet ring cells to potentially identify features indicative of mammary origin as opposed to other possible primary sites. The patients ranged from 41 to 76 (mean, 53.6) yr. Fourteen had a prior history of invasive breast carcinoma (invasive ductal carcinoma, 4; invasive lobular carcinoma, 3; adenocarcinoma not otherwise specified, 3; carcinoma with ductal and lobular features, 2; and unspecified carcinoma, 2) and metastases were identified 2 to 284 (mean, 79) mo after the original diagnosis. Three patients had no known history of invasive breast carcinoma: 1 was subsequently diagnosed with invasive lobular carcinoma, 1 had suspicious bilateral breast masses identified on imaging, and 1 was lost to follow-up. Bilateral ovarian metastases were present in 87%, and the tumors ranged from 3.8 to 19 (mean, 8) cm. Microscopically the ovarian architecture was effaced in 71% by discrete tumor lobules separated by striking edema. The tumors exhibited a variety of histologic patterns: nests were most common (88%), followed by cords (82%), diffuse sheets (82%), single cells (71%), small clusters (41%), glands (29%), and follicle-like cysts (12%). Signet ring cells comprised 2% to 70% (mean, 33%) of the tumors, with 14 cases meeting the criteria for Krukenberg tumor. Signet ring cells were most frequently observed within diffuse sheets (71%) and cords (65%). Tumor cells arranged in nests, cords, and diffuse sheets are typical of Krukenberg tumor of breast origin, and the patterns recapitulate those seen in primary breast carcinomas. Features characteristic of gastrointestinal origin, such as extracellular mucin, intestinal-type glands, dirty necrosis, microcysts, and goblet cell carcinoid-like foci, were absent. The overall morphologic picture in cases of ovarian spread of breast cancer with signet ring cells is usually strongly suggestive of mammary origin. The diagnosis can be further supported by the clinical history and immunohistochemical evaluation.
Topics: Adenocarcinoma; Adult; Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Carcinoma, Signet Ring Cell; Female; Humans; Krukenberg Tumor; Middle Aged; Ovarian Neoplasms
PubMed: 29045292
DOI: 10.1097/PGP.0000000000000462 -
Diagnostic Cytopathology Apr 2017Pleomorphic xanthoastrocytoma (PXA) is a WHO grade II astrocytic tumor of children and young adults. It is characterized by pleomorphic, atypical astrocytes. Atypia is... (Comparative Study)
Comparative Study
Pleomorphic xanthoastrocytoma (PXA) is a WHO grade II astrocytic tumor of children and young adults. It is characterized by pleomorphic, atypical astrocytes. Atypia is so remarkable, that PXA can be easily misdiagnosed as malignant glioma. If confused with a high-grade glioma the neurosurgeon may not proceed with a complete resection. Therefore, a specific recognition during intraoperative consultation is particularly important. We describe four cases of PXA evaluated during intraoperative procedures. Findings were compared with those of 22 glioblastomas. PXA smears were moderately cellular and showed a variable population of pleomorphic cells and fibrillary fragments with vessels. Tumoral cells were of intermediate size with a less frequent population of large, atypical cells. Some showed bi/trinucleation with bizarre nuclei. In two cases, tumoral cells with microvacuolization resembling xanthic astrocytes were present. No necrosis, mitotic activity, phagocytic macrophages or apoptotic fragments were seen. Smears from glioblastoma were more cellular than those of PXA with numerous neoplastic cells, branching vessels and myxoid substance. Cellular atypia was evident and mitoses were seen in all cases. Most cases showed an abundant population of accompanying macrophages and cellular debris. Differences between PXA and glioblastoma were related to cell turnover rather than cytomorphologic features. Glioblastoma shows features of high cellular replication showing a dirty background with necrosis and phagocytic macrophages as well as mitotic figures and apoptosis. On the other hand, smears from PXA have a clean background with no necrosis, cellular fragments or relevant mitotic activity. Diagn. Cytopathol. 2017;45:339-344. © 2016 Wiley Periodicals, Inc.
Topics: Adult; Aged; Biomarkers, Tumor; Brain Neoplasms; Female; Glioblastoma; Humans; Male
PubMed: 28084690
DOI: 10.1002/dc.23660 -
International Journal of Surgery Case... 2017Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of...
INTRODUCTION
Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of emergency in septic/dirty environment.
CASE REPORT
A 76-year old female patient (BMI 36.7kg/m) was admitted with mechanical bowel obstruction and sepsis caused by a third time recurred, incarcerated and eventrated abdominal wall hernia. During the emergency surgery perforation of the terminal ileum and the ascending colon was detected, along with a feculent peritonitis and extended abdominal wall necrosis. Extended right hemicolectomy and necrectomy of the abdominal wall were performed. The surgery resulted in an abdominal wall defect measuring 223cm, for the management of which direct closure was not possible. Using a specific method, an autologous dermal graft was prepared from the redundant skin. The first dermal graft was placed under the abdominal wall with 5cm overlap, and the second layer was placed onto the first layer with 3cm overlap in a perforated fashion. The operating time was 250min. No significant intra-abdominal pressure elevation was measured. No reoperation was performed. On the fifth postoperative day, the patient was mobilised. She was discharged in satisfactory general condition on the 18th postoperative day. There is no recurrent hernia 8 months after the surgery.
DISCUSSION
Abdominal wall reconstruction was possible in a necrotic, purulent environment by using a de-epithelised autologous double layer dermal graft, without synthetic or biological graft implantation. The advantage of the procedure was cost-effectivity, and the disadvantage was that only in an obese patient is the sufficient quantity of dermal graft available.
CONCLUSION
A homogeneous internal and perforated outer dermal graft was suitable for bridging the abdominal gap in the case of an obese, high risk patient. Autologous dermal grafts can be a safe and feasible alternative to biological meshes in emergency abdominal wall surgeries. Evaluation of a case series can be the next cornerstone of the method described above.
PubMed: 28012327
DOI: 10.1016/j.ijscr.2016.12.002 -
Histopathology Jan 2017Colorectal carcinoma (CRC) with micropapillary (MP) features has only been described recently and is still being characterized.
AIMS
Colorectal carcinoma (CRC) with micropapillary (MP) features has only been described recently and is still being characterized.
METHODS AND RESULTS
We reviewed the clinicopathological and molecular features of 42 CRC with MP features. Twenty-nine cases were also evaluated for immunohistochemical evidence of epithelial-mesenchymal transition (EMT). The extent of MP features within our cohort ranged from 5% (13 cases) to 100% (one case). Twenty-seven cases featured prominent cribriforming with dirty necrosis in the non-MP component; nine displayed mucinous features. Twenty-four of 29 cases (83%) demonstrated evidence of EMT. Thirty-six cases (86%) showed advanced T-category (pT3 or pT4), 31 (74%) had lymph node metastases and 23 (55%) had distant metastases. Median overall follow-up was 36 months. Seventeen patients (40%) died of disease, with median survival of 23 months. Mutations were seen in 17 of 31 tested cases (55%), including 11 KRAS mutations and four BRAF V600E mutations. Microsatellite instability testing was performed on 21 cases; all were microsatellite-stable. Compared to a cohort of 972 conventional CRC, MP CRC was more likely to present as stage IV disease (P < 0.001), but patients with MP CRC showed no significant differences in overall survival after adjusting for stage.
CONCLUSIONS
Micropapillary features in CRC portend a high likelihood of advanced local disease and distant metastases. MP CRC is often associated with a cribriform pattern elsewhere in the tumour and cystic nodal metastases with prominent necrosis. They also show frequent mutations in KRAS and BRAF. Immunohistochemical evidence of EMT is common in MP CRC.
Topics: Adenocarcinoma, Papillary; Adult; Aged; Colorectal Neoplasms; DNA Mutational Analysis; Epithelial-Mesenchymal Transition; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Male; Middle Aged
PubMed: 27560620
DOI: 10.1111/his.13068